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Systemic Antifungal Agents

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Diagnosis and Treatment of Fungal Infections

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Abstract

Systemic antifungal drugs used to treat serious fungal disease fall chiefly into three drug classes—azoles, echinocandins, and polyenes. A fourth class, pyrimidine analogues, consists of a single agent, flucytosine, that is only used in combination with other antifungals. Both azoles and polyenes target the cell membrane, while echinocandins specifically target cell wall synthesis. This chapter details drugs mechanisms of action, spectrum of activity, pharmacokinetics, and toxicities associated with the clinical use of currently approved systemic antifungals to treat life-threatening mycoses. In addition to drug characteristics, the detection and interpretation of antifungal resistance is discussed for common clinically relevant species.

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Suggested Reading

  • Berkow EL, Lockhart SR, Ostrosky-Zeichner L. Antifungal susceptibility testing: current approaches. Clin Microbiol Rev. 2020;33:e00069.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Perlin DS, Rautemaa-Richardson R, Alastruey-Izquierdo A. The global problem of antifungal resistance: prevalence, mechanisms, and management. Lancet Infect Dis. 2017;17:e383–92.

    Article  PubMed  Google Scholar 

  • Rauseo AM, Coler-Reilly A, Larson L, Spec A. Hope on the horizon: novel fungal treatments in development. Open Forum Infect Dis. 2020;7:16.

    Article  Google Scholar 

  • Stott KE, Hope WW. Therapeutic drug monitoring for invasive mould infections and disease: pharmacokinetic and pharmacodynamic considerations. J Antimicrob Chemother. 2017;72:i12–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences, Infectious Diseases, IRCSS Sant Orsola University Hospital, University of Bologna, Bologna, Italy

    Russell E. Lewis

  2. Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Nathan P. Wiederhold

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  1. Russell E. Lewis
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  2. Nathan P. Wiederhold
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Correspondence to Russell E. Lewis .

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Editors and Affiliations

  1. Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Duane R. Hospenthal

  2. Departments of Pathology, Microbiology, and Clinical Laboratory Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Michael G. Rinaldi

  3. Departments of Medicine and Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, MD, USA

    Thomas J. Walsh

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Lewis, R.E., Wiederhold, N.P. (2023). Systemic Antifungal Agents. In: Hospenthal, D.R., Rinaldi, M.G., Walsh, T.J. (eds) Diagnosis and Treatment of Fungal Infections. Springer, Cham. https://doi.org/10.1007/978-3-031-35803-6_8

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